Symposium Speakers

Keynote Speakers

Sir Mark Walport is Director of the Wellcome Trust, a global charitable foundation dedicated to achieving extraordinary improvements in health by supporting the brightest minds. Before joining the Trust he was Professor of Medicine and Head of the Division of Medicine at Imperial College London. He has been a member of the Prime Minister’s Council for Science and Technology since 2004. He is also a member of the India UK CEO Forum, the UK India Round Table and the advisory board of Infrastructure UK and a non-executive member of the Ofﬁ ce for Strategic Coordination of Health Research. He is a member of a number of international advisory bodies.

He has undertaken independent reviews for the UK Government on the use and sharing
of personal information in the public and private sectors: ‘Data Sharing Review’ (2009) and secondary education, ‘Science and Mathematics: Secondary Education for the 21st Century’ (2010).

He received a knighthood in the 2009 New Year Honours List for services to medical research and was elected as Fellow of The Royal Society in 2011.

Laureate Professor Peter Doherty AC is an Australian veterinary surgeon and researcher in the ﬁ eld of medicine. He received the Albert Lasker Award for Basic Medical Research in 1995, the Nobel Prize in Physiology or Medicine jointly with Rolf M. Zinkernagel in 1996 and was named Australian of the Year in 1997. In the Australia Day Honours of 1997, he was named a Companion of the Order of Australia.

Professor Doherty’s research focuses on the immune system and his Nobel work described how the body’s immune cells protect against viruses. He and Rolf Zinkernagel, the co-recipient of the 1996 Nobel Prize in Physiology or Medicine, discovered how T cells recognize their target antigens in combination with major histocompatibility complex (MHC) proteins.

Mr Simon McKeon was named Australian of the Year in January 2011 for his efforts to support multiple Australian and international charities.

In the early to mid 1990’s Simon transitioned into a part-time role as Executive Chairman of Macquarie Group’s Melbourne ofﬁce, enabling him to support a range of causes and organisations, including joining the board of World Vision Australia.

Simon is currently Chairman of the CSIRO and Business for Millennium Development, which encourages business to engage with the developing world.

His association with World Vision International continues and he is involved with the Global Poverty Project and Red Dust Role Models, which works with remote Indigenous communities. A leading social entrepreneur, Simon demonstrates how business and philanthropy go hand in hand, giving tremendously of his time and energy to many organisations.

Dr Susan Alberti AO is the co-founder of a successful commercial, industrial and property development business, philanthropist and board member of the Western Bulldogs Australian Rules Football Club.
Sue has dedicated her life to ﬁ nding a cure for juvenile diabetes and fund raising towards Australian health and medical research.

She is National President of the Juvenile Diabetes Research Foundation Australia, Foundation Chairman of the St.Vincent’s Institute for Medical Research and was awarded her Order of Australian 2007 in recognition of her long and outstanding contribution to major medical research institutions, particularly as a philanthropist, fundraiser and advocate for juvenile diabetes care and research. Sue also founded the Susan Alberti Charitable Foundation (SACF). The SACF has alone raised $5million towards diabetes research. Apart from the SACF she has also raised millions of dollars towards medical research over many years.

Symposium Abstracts

SESSION 2: IMPROVING INDIGENOUS HEALTH

In recent years, commitment to overcoming Indigenous health disparity has seen increasing investment in chronic disease prevention and management. Yet the determinants remain poorly understood, and efforts remain largely framed around a false notion that chronic diseases can be overcome by altering ‘bad’ behaviour among ‘bad’ people. Our program of work seeks to better elucidate the broad determinants of chronic disease disparity in Indigenous people, so as to target health system and policy interventions. The experience of chronic disease among the disadvantaged can provide insights into essential targets to improve outcomes for all people with or at risk of chronic disease.

SESSION 3: BUILDING NATIONAL WEALTH THROUGH INNOVATION AND NEW INDUSTRIES

Dr Chris Roberts
Cochlear Limited is a medical device company leading the world in implantable devices for the hearing impaired, such as cochlear implants. Prof Graeme Clark is recognised as the inventor of the cochlear implant for his pioneering work in the ﬁ eld while at University of Melbourne, although it was commercialised successfully from Australia by the entrepreneur Paul Trainor through his Nucleus group of companies.

While cochlear implants have provided the gift of hearing to over 150,000 severely and profoundly hearing impaired adults and children globally, Cochlear Limited as a company has made a signiﬁ cant contribution to the Australian economy, and is a great example of the virtuous cycle that can result from health and medical research. For example, while 95% of Cochlear’s sales are outside Australia, almost 90% of the taxes Cochlear pays are to State and Federal Governments in Australia. Over 1,000 people are directly employed by Cochlear in Australia including in advanced manufacturing as well as research and development. In F11 over $100 million was spent on research and development, and around 300 people were directly employed in these research activities. Cochlear is also a key part of the Hearing Precinct being built on campus at Macquarie University where some 2,000 people will be collocated, working on different aspects of hearing activities.

Australian researchers have contributed extensively during the 20th Century to understanding the pathophysiology of disease. Antibiotics (Penicillin), vaccines (HPV), and small molecule drugs (Relenza) have originated from Australian research. However translation of these discoveries into clinical practice has largely depended on work done elsewhere. Should we be concerned about this? The opportunities for new health interventions in the 21st Century will look rather different from those in the 20th Century – “blockbuster” small molecule drugs that become a routine part of management of common chronic disease are dependent on large and lengthy clinical trials, and hence on $1b+ per annum sales to recover development costs. Opportunities for new blockbusters will be limited by the success of existing interventions, and focus will shift to development of custom biopharmaceuticals working through manipulation of physiological processes by mimicry, and requiring smaller trials. Australia should focus on improving its capacity to discover biopharmaceuticals and to take these through to market, and become a preferred supplier of innovative quality interventions to the major emerging economies in our region. This will require continued investment by government not only in basic science, the engine that drives the discovery process, but also in the translational component of product development, through further investment in clinical research. As we enter the era of chronic non-infectious diseases, this investment, together with a corresponding investment in public health, should be well repaid in improved national health as well as returns to the Australian economy.

Mr Will Delaat
Australian Medicines Industry – Supporting the Nation’s Health and Wealth
The medicines industry is one of Australia’s most vibrant and research-intensive industries. It consists of Australian subsidiaries of multinational corporations and hundreds of smaller Australian-based medical biotechnology companies (of which 63 are currently listed on the Australian Securities Exchange with a combined market value of $23.4 billion).

Since 2004, the Australian medicines industry has invested approximately $6 billion in Australian R&D and initiated over 4,500 clinical trials in more than 30 therapeutic areas. It employs over 40,000 highly-skilled Australians, of whom around 13,000 work in research and development directly. It generates $4 billion in exports each year, making it Australia’s largest exporter of high-tech goods; bigger than the car and wine industries. Most importantly, the Australian medicines industry researches, develops, manufactures and distributes innovative medicines and vaccines that millions of Australians use every day to live longer, healthier and happier lives.

The medicines industry’s success in Australia has been in large part due to the fact that this country is home to some of the world’s best researchers and healthcare professionals, who in turn have access to a world-class research and healthcare infrastructure. But as countries in Asia and South America improve their domestic capabilities, Australia’s ability to leverage its traditional strengths to attract investment is under threat. It is important for us to remain alert to global policy trends and adapt our local environment so that the new generation of Australian scientists and healthcare professionals continue to have opportunities to work in one of Australia’s most remarkable industries – an industry which is responsible for bringing such ground-breaking products as Gardasil® and Relenza® to the global market. Crucially, with the right policy settings, such as the implementation of the R&D Tax Credit and the Clinical Trials Action Group’s recommendations, Australia can gain a long term competitive advantage in the ever present global race to secure R&D investment.

Dr Anna LavelleBeneﬁting from Health and Medical Research: Improving Patient Care
Australians medical discoveries have improved the quality of health for millions of people across the world, built on a long and proud history of research. Research is vital at the beginning and throughout the value equation, and links with industry provide the commercialisation function that delivers solutions, treatments and diagnostics to the community.The Australian biotechnology industry has more than 1,000 companies in therapeutics, diagnostics and medical devices, making it a leading location for biotechnology. This session looks at the role of medical research, healthcare reform, and the challenges faced by the sector.

SESSION 4: IMPROVING PATIENT CARE

Dementia is a synaptic disease of multiple interacting aetiologies that currently affects 34 million individuals worldwide and forecast to increase to 100 million by 2050. In order to normalize cognitive function in individuals with dementia, new treatment approaches are needed that can rebuild depleted synaptic networks. Stem cell therapy is one possible strategy, but there are a number of challenges before human trials can proceed. One the main obstacles is the poor predictive validity of transgenic rodent models of Alzheimer’s disease. The Regenerative Neuroscience Group has therefore been investigating the regenerative potential of skin-derived neuroprecursors sourced from adult dogs. This strategy has three main beneﬁts. Firstly, 10-15% of companion dogs aged over 10 years of age naturalistically develop a dementia syndrome with pathological, clinical, cognitive and pharmacological similarities to human dementia, and so may represent a key translational model for preclinical research. To aid diagnosis and clinical assessment, we developed the Canine Cognitive Dysfunction Rating scale and the Canine Sand Maze. Secondly, a skin-derived tissue source makes possible the creation of patient-speciﬁc cell lines for therapy, averting complications related to tissue rejection. Our in vitro protocol for culturing adult canine skin-derived neuroprecursors excludes the growth of glial cells and produces exclusively immature neurons. These cells could be effective for rebuilding synaptic networks in the aged brain, however, in order to do so biological control of their in vivo migration, survival and integration is critical. Accordingly, our third main interest has been exploring the synergistic value of combining voluntary running with transplantation of canine skin-derived neuroprecursors in aged rodents with memory dysfunction. Early data shows that these cells can engraft into different areas of the hippocampus and effectively restore recognition memory back to the level of young animals. Design of a clinical trial of patient-speciﬁc, skin-derived neuroprecursor cell therapy in older dogs with Canine Cognitive Dysfunction is now underway, and will provide key data as to whether such an approach can succeed in humans.

Tremendous progress has been made in our understanding of genetics over the last century. What makes us unique individuals is not just the set of genes that we inherit from our parents. It includes other molecules bound up with the DNA called epigenetic marks that inﬂ uence which genes will be switched on. The ﬁ eld of epigenetics, initiated in the 1940s, is undergoing a renaissance due to the development of technologies to detect these marks. Epigenetic states can be altered by the environment and once established they can be stable for the life of the individual, providing an opportunity for the epigenome to be useful in preclinical and clinical diagnosis.

Dr Tania de Koning-WardUnravelling how malaria parasites make red blood cells their home

Central to malaria pathogenesis is the ability of the causative Plasmodium species to remodel their host red blood cell, a process that involves the export of ~5% of the parasite proteome beyond an encasing vacuole into the cytosol of the host cell. The Plasmodium Translocon of EXported proteins (PTEX), which localises to parasite-host cell interface, is predicted to provide the portal through which parasite proteins can access the host red blood cell. Five proteins are known to comprise the PTEX complex and we are currently characterising these proteins using molecular, biochemical and imaging approaches to advance our understanding of protein export and to delineate the functional signiﬁcance of the translocon to pathogenesis. These studies have enabled us to reﬁne our model of protein export and importantly have revealed that the predicted core PTEX components are essential to parasite survival. Hence, these components will make attractive drug targets for potentially preventing the export of hundreds of proteins crucial to parasite virulence and survival.

Professor Jenny Martin“Bragging rights”

Australia’s ﬁrst Nobel prize winner, Lawrence Bragg, was awarded the Physics prize in 1915. He was 25 years old at the time, and remains the youngest ever Nobel laureate. Bragg’s discoveries have since revolutionized medical research, though he had no inkling of this at the time. As one of Bragg’s scientiﬁc grandchildren, my medical research is directly descended from his ﬁndings. This presentation will explain how.

SESSION 5: IMPROVING PATIENT CARE

Professor Christopher GoodnowMendel’s Long tail: the impact of mis-sense mutations on immunity

Genome sequencing of hundreds of “normal” people has revealed that we are all mutants: each of us inherits ~12,000 DNA variants that alter the sequence of our body’s proteins. Most are “mis-sense” variants that change a single amino acid, and thousands are predicted to be damaging to the protein.

We now have the technology to catalogue the DNA variants present in Australians with autoimmune or immunodeﬁ ciency diseases, or lymphoid cancer, but how do we sort wheat from chaff to understand why these chronic diseases occur and to match expensive new treatments to patients likely to respond?

Here I will summarize our efforts to tackle this problem, made possible by an NHMRC Australia Fellowship, by integrating experimental analysis of mis-sense variants in mice with genome analysis in patients.

The ability to mount high afﬁnity and long-lived antibody responses underpins the effectiveness of practically every successful vaccine to date. Until recently, the type of T cells that drove these high quality antibody responses was unknown. Over the last few years our work has contributed to the identiﬁcation and characterization of a unique T cell subset: T follicular helper (Tfh) cells, as the cell type responsible for provision of help to B cells for antibody production. Elucidation of Tfh development, mechanism of action and regulation has provided new insights into how antibody responses are triggered and how they can be improved and controlled. This knowledge can be applied to the design of more targeted therapies for autoimmune diseases such as lupus and rheumatoid arthritis, in which dysregulated Tfh activity causes selection of rogue antibodies that damage our own tissues or worsen disease. Understanding how Tfh cell formation can be boosted will be critical for the development of vaccines against infectious diseases such as HIV and malaria and for the treatment of common immunodeﬁciencies. Finally, therapies aimed at neutralising Tfh cells or boosting their negative regulators may prove useful for the treatment of T and B follicular lymphomas.

Antibodies are the basis of most successful vaccinations. Diminished antibody responses lead to immunodeﬁciency while excessive antibody responses contribute to autoimmune diseases. We are studying a newly identiﬁed specialised helper T cell subset, termed follicular helper T (Tfh) cells, which is essential to regulate the high-afﬁnity and long term antibody responses. In last few years, we have identiﬁed the key transcription factor Bcl6 directing the differentiation of Tfh cells and demonstrated excessive Tfh cells promoting autoimmunity using animal models.

Utilizing the knowledge gained from animal models, we are currently investigating Tfh cells in human subjects and have identiﬁed a distinct population, designated as Tfh effector memory (Tfem) cells, in blood after vaccinations. Tfem cells are capable of rapidly differentiating into mature Tfh cells upon antigen re-encounter and their differentiation shares many common molecular pathways as Tfh cells. A proportion of autoimmune patients with rheumatoid arthritis or system lupus erythematosus showed increased Tfem cells. Importantly, the patients with high Tfem cells were diagnosed of signiﬁcantly higher disease activities. This study not only identiﬁes a new Tfh effector memory population with clear differentiation pathways but also provides a powerful tool to assess both protective and pathogenic Tfh programs in humans.

Professor James WhisstockTranslation of Basic Medical Research – the early stages

A key challenge that commonly faces medical researchers is making the leap from basic biomedical discoveries through to translational directions that directly impact on human health. In this talk I will discuss how we have used mechanistic and structural studies on the enzyme Glutamic Acid Decarboxylase to understand one likely molecular basis for anxiety (and related) disorders. I will further discuss our current efforts in regards to translating these discoveries via small molecule drug discovery.

SESSION 6: IMPROVING POLICY AND PRACTICE IN THE HEALTH SYSTEM

Professor Paul GlasziouImproving Research’s Useability and Use

The growth of medical knowledge, and the consequent changes in health policy and clinical practice, has considerable potential to improve patient care and health. However, effectively using this knowledge is itself an increasing problem. The volume of new information is vast: each day MEDLINE adds over 2,000 studies, including 3 new guidelines, 5 systematic reviews and 50 trials, and each week we describe at least 1 “new” disease. However not all changes recommended are improvements. Many changes are passing fashions that waste our time and efforts, distracting us from the real work of clinical care and competing for attention with good innovations that lead to real improvements in care. Hence an essential task in health care is learning to pick fashion from good innovation.

To better manage our wealth of information we must (i) identify which are the essential changes in practice and which are fashions, and (ii) learn how to make the needed changes happen and stick. Numerous methods that have been tried to improve the diffusion of appropriate (and decrease the diffusion of inappropriate) innovations, but the pace of change seems to grow faster than our coping strategies adapt. While the “science” of both steps has improved over the past few decades, we still have no “magic bullets”.

Recent work has documented more clearly the problems in both the production and reporting of research which interferes with the uptake of evidence. Solving these problems is essential to providing a credible and usable evidence-base for changes. In parallel, our understanding of the impediments to change and innovations in change interventions has improved, and is slowly evolving into a science. This session will cover some of the needed changes in research and knowledge management, and the improvements in behavioural science techniques needed to close the evidence-practice gap.

Professor Helena TeedeImproving Translation of Research into Policy and Practice - completing the circle

Investment in knowledge generation through research is substantial, yet barriers limit translation to improved health care outcomes. Research should be guided by identiﬁ ed clinical gaps or national health priorities. Knowledge generation, should then contribute to knowledge synthesis, implementation and dissemination, reaching a broad range of stakeholders (consumers, health professionals and policy makers). Dissemination is important, but requires implementation with behaviour change/system adaptation informed by implementation research, to drive evidence into clinical practice. An exemplar will be provided. With NHMRC leadership and increasing successful exemplars, better health returns on research investments and improved health care outcomes should be expected.

Modern health care systems are remarkably successful at delivering access to health care irrespective of individual ability to pay; but this success has come at a cost. In Australia, that cost represents almost 10% of the country’s economic activity and that is predicted to increase. Health services research is a multidisciplinary ﬁ eld which addresses many aspects of the design, effectiveness and efﬁ ciency of this economically important sector. WHO describes it as ‘the brains of the health system’. This presentation demonstrates how this research has had an impact through a number of examples. As Australia embarks on an ambitious program of health system reform, and struggles to meet the challenges of the 21st century, investment in “the brains’ of the health system” will become even more important.

SESSION 7: MENTAL HEALTH AND DEMENTIA

Professor Philip MitchellCan we predict who will develop bipolar disorder?

At present we have no means of identifying young people at increased risk for developing bipolar disorder, beyond knowing that this is a highly heritable disorder. Consequently, there is no evidential basis for developing early intervention or preventive programs for this condition. Unlike schizophrenia, there is no current convincing evidence for a prodrome. In this presentation, I will ﬁ rstly review clinical data emerging from a number of prospective longitudinal ‘high-risk’ studies of children and siblings of patients with bipolar disorder presently being undertaken in the US, Canada and our own research in Australia. There is growing evidence that those who ultimately develop bipolar disorder present initially with a range of non-speciﬁ c symptoms, the most prominent of which is anxiety. Secondly, I will review the emerging biological data on those at-risk for bipolar disorder. Two groups (in the UK and US) have reported abnormalities in white matter pathways using diffusion tensor imaging (DTI) in unaffected ﬁ rst-degree relatives of those with bipolar disorder, while our own group has demonstrated reduced inferior frontal gyrus activation on fMRI during an emotional inhibition task suggesting a trait disturbance in emotional regulation pathways. In summary, the data emerging from these ‘high risk’ studies holds the promise of providing clinical and biological ‘proﬁ les’ which may enable the future development of targeted early intervention programs.

Epidemiological and randomised trial data show that even if it were possible to reach all patients and provide evidence-based treatments, the effect on averting years lived with disability would be inadequate. New patients emerge and currently available treatments have limited effectiveness. Many randomised trials demonstrate that preventive interventions can reduce the incidence of new episodes of major depressive disorder by about 25%. However, the million dollar question is how to deliver these prevention interventions to the community, and have them taken up, when those at risk are essentially “healthy”, or unaware of their risk. Moreover, many prevention interventions involve intensive group- or individual based cognitive behaviour therapy interventions, which are expensive, and difﬁ cult to deliver with a limited workforce. A solution has been to use online automated e health applications which deliver cognitive or other therapeutic interventions directly to individuals but which can be disseminated widely through the Internet. In this presentation, I provide evidence for the effectiveness of these interventions in depression and suicide prevention, using data from ARC and NHMRC funded projects, discuss the potential difﬁ culties in the widespread delivery for prevention, including issues with engagement, adherence, stigma and workforce. NHMRC funding has been critical to the evidence base of new forms of e health in Australia, and to inﬂ uencing policy and health services, as evidenced by changes in the recent Commonwealth budgets.

Professor Perry BartlettActivation of different neurogenic precursor populations in the hippocampus: potential for dementia and depression therapy

The production of new neurons in the hippocampus is thought to underpin aspects of learning and memory. Deﬁ ning how neurogenesis is regulated is central to our understanding of the learning process and to the future development of neurogenic-based therapeutics aimed at ameliorating cognitive loss.

Recently, we identiﬁ ed a large precursor pool in the dentate gyrus of the mouse hippocampus, including a small number of true stem cells, which is normally dormant but can be activated by depolarizing levels of K+ to produce large numbers of neurogenic neurospheres. In situ stimulation of the perforant pathway also activates this precursor population and leads to an increase in newly born neurons. Importantly, this population can be activated in the aged mouse, uncovering the potential for signiﬁ cant neurogenesis in the ageing brain.

Further, synaptic activity stimulates precursor activity through the release of a number of soluble factors and the neurotransmitter, norepinephrine (NE). These factors act directly on the precursors with NE activating through a novel adreno-receptor pathway. Interestingly, different stimuli led to the activation of different pools of precursors and stem cells, suggesting production of hippocampal neurons in the dentate gyrus with distinct properties reﬂ ective of a speciﬁ c stimulation process. This provides a mechanism by which the functional capacity and the number of newly generated neurons can be directly inﬂ uenced by the type and complexity of environmental stimuli.

Professor Henry BrodatyDementia: A national health priority

Dementia is deservedly a national health priority. Its prevalence in Australia will quadruple from 0.25 to 1 million in the next 40 years with consequences for their families, the aged care workforce (already experiencing shortages), demand for residential care and the economy as dementia costs now exceeds $6 billion annually.

Research goals span epidemiology (why do Aboriginal people have such a high rate of dementia?), cause (what is aetiology of Alzheimer’s disease), prevention (can population targeted interventions delay dementia?), early diagnosis (biomarkers and improving general practice diagnosis), treatment (drug discovery, clinical trials), clinical care (improving outcomes for people with dementia in hospitals), management of behavioural and psychological symptoms of dementia (such as agitation and aggression), improving nursing home care, reducing carer stress, and better palliative care.

Australian researchers have identiﬁ ed Alzheimer’s disease pathogenetic pathways, demonstrated potential of presymptomatic diagnosis using amyloid PET imaging and calculated risk factors for Alzheimer’s disease. Epidemiologists have indentiﬁ ed modiﬁ able environmental risk factors. Alzheimer’s can be diagnosed pre-symptomatically with neuroimaging using PET PiB compound. While drug trials have not yet succeeded in modifying AD there are promising leads. Psychosocial interventions including our own randomised controlled trials have demonstrated effectiveness: reducing caregiver distress, delaying nursing home admission of people with dementia and decreasing agitation in nursing homes.

The challenges of research into the dementias are great and the canvas broad but so are the needs and the opportunities.

Typically in translational medicine we propose strategies to bring ideas from bench to bedside. However, the translational process is not linear from the lab to the clinic and it is best conceptualized as a loop with a bidirectional ﬂ ow that includes taking ideas from the clinic to the bench in order to identify mechanisms of action leading to conceptually novel interventions. This process can be exempliﬁ ed by the clinical observation of antidepressant-induced weight gain. Clinically, many but not all depressed patients, exposed to antidepressant treatment, gain weight over time. Moreover, the use of antidepressants has become very widespread, as they constitute the second group of most sold medications, right after analgesics. Obesity rates have skyrocketed simultaneously with the increased use of antidepressants. Could there be a connection between antidepressant treatment, weight gain, and obesity? In collaboration with colleagues in population health we are investigating the impact of antidepressant use on body weight at the community level. In our own lab, we have developed an animal model of short-term stress with concomitant antidepressant, which is then discontinued and followed by long-term high-fat diet. We discovered that previous exposure to stress and antidepressants leads to long-term weight gain in the context of high fat diet. The next steps are to elucidate the mechanisms for our ﬁ ndings, which are consistent with the previously described phenomenon of time-dependent sensitization. This line of inquiry demonstrates that clinical observations can guide both epidemiological work as well as mechanistic molecular neurobiology research of therapeutic relevance.

SESSION 8: IMPROVING PREVENTION AND PUBLIC HEALTH

The prevention of skin cancers is a national priority because they cause an enormous and disproportionate burden on the Australian health system. My goal is to reduce this burden through prevention research that is translatable to the community. The high incidence rates of skin cancer in this country make this feasible

– it is a rare opportunity when a public health researcher can investigate ‘cancer prevention’ directly as a project outcome, with relatively modest resources! Through a long-term study that followed a Queensland community sample for 20 years, and that included a randomised trial, we alone have been able to show that regular sunscreen application is a cost-effective strategy for the prevention of two major skin cancer types. Our challenge now is to conduct cutting-edge behavioural research that will guide approaches to promoting basic sun protection strategies successfully in the Australian population, including the effective use of sunscreen. The greatest challenge however is to achieve maximum prevention impact through lasting behavioural change among teens and young adults when outdoors, and thus substantially reduce their skin cancer incidence in later life.

Professor Josephine Forbes

Type 1 or juvenile diabetes (T1D) has no cure and is increasing by 6% per year, affecting 130,000 individuals within Australia and accounting for some 40% of the overall cost of diabetes to Australia. Forty percent of children and adolescents with T1D go on in adulthood to have heart attacks and strokes as a result of kidney disease which shortens their lifespan on average by 15 years. A/Prof Forbes has focused on the potential mechanisms that can explain why preventing the accumulation of “caramel-like” substances called AGEs within our bodies, is an effective strategy for suppressing diabetic kidney disease and indeed contribute to the development of diabetes itself.

Climate change endangers human health and survival via heat and other weather extremes, impacts on food yields, freshwater availability, infectious disease patterns, displacement and conﬂict. Some health gains may also result. This century’s warming will almost certainly exceed the Holocene’s temperature ﬂuctuations (mostly within a 1.5¬oC range), both in magnitude and rapidity. Our research has begun to clarify the main acute and longer-term risks to health in Australia, differences in regional and social vulnerability, and the likely future trajectories in health risks under standard climate change scenarios. Mitigation actions (true primary prevention) will often also confer bonus local health beneﬁts (cleaner air, more physical activity, etc.). Meanwhile, we are also developing strategies for prioritising and evaluating risk-management ‘adaptations’.